This Doctor Likes iPhones & Handheld Tech

"When you make a thing, a thing that is new, it is so complicated making it that it is bound to be ugly. But those that make it after you, they don’t have to worry about making it. And they can make it pretty, and so everybody can like it when others make it after you."

- Pablo Picasso

Comments

Technology continues to democratize many fields. PCs did it for programming. Word and photoshop did it for publishing. 3D printers and laser cutters are doing it for manufacturing. So why not medicine? Of course, not every garage shop can afford an MRI, but things like that shown in the video are paradigm-shattering.

-Phil

Perfection is achieved not when there is nothing more to add, but when there is nothing left to take away. -Antoine de Saint-Exupery

No, sorry. I was never any good at, so tend to avoid, the "squishy sciences" like biology and chemistry.

-Phil

You're going to have to think of a better excuse, Phil. It's called the "microMedic" contest and this means the entries are judged according to their use of microcontrollers. You know all about microcontrollers, programming, sensors and electronics. The only squishy thing you need is some kind of medical training body. It doesn't have to be squishy anyway. Heck, just go to the downtown metropolis of Port Townsend and borrow one of those plastic mannequins from a storefront. Figure out a neat project - either load it with sensors for some medical simulation, or blast it with metal and make a field shrapnel detector.

And as a gentle reminder, you provided Browser lots of care with a special apparatus for providing shots. Not only was he squishy, he was a living cat! I still don't buy the excuse.

Therefore, with the highly limited power vested in me by the United States of America US Army's Telemedicine and Advanced Technology Research Center and as a contractor to Carnegie Mellon University Entertainment Technology Center, I hereby proclaim:

No, sorry. I was never any good at, so tend to avoid, the "squishy sciences" like biology and chemistry....

Yeah, back in my youth, I used to be like that. But then I got a squishy wife, had some squishy kids, had to change a lot of squishy diapers, and got kinda squishy myself. Now I'm up to my eyebrows in all this squishy stuff. Biological stuff seems to grow on you after awhile. Which is why antibiotics were invented, you know. But, dangit Phil, I was looking forward to your applying one of those fancy thermal sensors to this contest. In fact I was beginning to think you weren't rolling out your thermal camera just yet because you were going to wait to debut it for this contest. Bummer, dude.

All kidding aside, I do believe there are some annoyingly persistent cultural and psychological barriers standing between the mentalities employed by different fields of expertise. I sometimes find myself forcing my brain to downshift, drool a little, and "think like a biologist" to solve a problem involving some sort of squish. Physicists and engineers often want things to be clean-cut and crystalline (dare I say sterile?) in their simplicity while people in the arts aren't happy unless they're wallowing in iridescent gutters of emotion and celebrating incomprehensibility with dionysian eruptions of oil paint and dadaistic dance routines. When it comes to biologists, I sometimes find it necessary to beat them with a rolled up newspaper until they think more logically and less squishfully, but you sometimes just have to shrug your shoulders, roll up your sleeves and grab the bull by the.... uh... the uh....

It kind of funny, but a lot of things in medicine depend on listening, knowing what to ask and knowing how to examine somebody. I went to an acute care clinic recently - all they wanted to do was get different tests - none of which were necessary. Medicine usually doesn't provide certainty, but figuring things out is a large part of the fun when dealing with patients. Those who want more certainty end up making medical devices.

That was interesting and reminds me of all of the things I thought of when I went from being a programmer doing electrophysiology/neuropharmacology research into medicine. Somehow over the last 20 years my wetware has morphed into a precise diagnostic instrument that lets me use a stethoscope, reflex hammer and a few other simple tools to come up with diagnoses without needing a lot of extraneous hardware. My hacker persona likes toys, and I'd love to have an echocardiograph in my office but the $8K price tag is somewhat inhibiting. The video is heavily slanted towards the US medical system as, when I did my own EKG's in the office, I was paid $15.50 for both the technical fee and interpretation fee for the EKG. An echocardiogram in Canada costs substantially less than $800.

My primary beef with this video is the cardiologists fascination with his iPhone. Nothing could be further from open-source and an Android phone should be the building block for medical apps. In the US, where one has private billing, there's an incentive to have all of the tests done in the office as they're immediately available to discuss with the patient and one can bill for them. In Canada, under socialized medicine, one can only bill for what the government decrees as billable. Thus, while it would be immensely helpful for me to measure patients INR, electrolytes, CBC and do an echocardiogram in my office, none of that could be billed for; in fact it is illegal to bill for such tests in Canada as they are offered in government licensed labs.

Where I've utilized physiologic monitoring is in the area of objective psychiatry using patterns of heart rate and activity to get psychiatric diagnoses. This has saved huge amounts of office time with patients when I can show them a HeartLink monitoring of 24 hours of heart rate activity and a characteristic unipolar depressive pattern. This is something I can't bill for, but it saves those multiple visits by patients asking endlessly "how do you know I'm depressed?". Duplicating that is part of my Ambulatory Physiologic Monitor project for the contest.

The other factor that wasn't brought out in the video clip is that the medical system is extremely conservative and making even small changes is very difficult, especially when there is a huge vested financial interest in present ways of doing things. With open source hardware and software, people will start doing self-monitoring on their own and eventually the medical system will follow. I'd love to have an implanted physiologic monitor that would be powered by blood flow and transmitting chemical and electrical parameters wirelessly to my laptop every second. Will probably have to wait a while longer as first came up with this idea over 20 years ago and only now are some of the monitoring abilities available for use.